by Rose George
I’m still waiting for the blood, but there is plenty to keep me hopeful that the borders of the taboo, so fixed until now, are wavering and shifting. In 2015, Time magazine showed a tampon (unused) on its cover, which held the headline YEAR OF THE PERIOD. Period blood has appeared all over the place, from artists using it to make gorgeous swirly images; to Rupi Kaur, a poet, faking it in an Instagram post, showing her bleeding through gray sweatpants; to the musician Kiran Gandhi running the London marathon as a “free-bleeder,” bleeding freely into her conveniently red sweatpants. (She claimed that she did it because she wouldn’t have any privacy to change a tampon, an odd statement when the London marathon is probably the only time of the year that Londoners can find sufficient numbers of public toilets.)
Suddenly there was tennis player Heather Watson saying she lost a match because of “girl things,” or, more straightforwardly, the Chinese swimmer Fu Yuanhui telling an interviewer, as she stood dripping water after an Olympic event, that she had performed poorly “because my period came yesterday, so I felt particularly tired.”72 She hadn’t won her race, but this statement got her more coverage than any medal would have. Behind the color and noise, there is real money. Venture capitalists, those male-dominated businesses, are funding women-run period businesses like Thinx, which makes underwear you can bleed into, and advertising—using graphic and cunning pictures of vagina-resembling grapefruit, a category unknown to fruit growers—you can’t avoid; or Flex, a “menstrual disc” that captures blood and in 2016 secured $4 million in funding. There are organic cotton tampon companies such as Lola and Maxim building on environmental worries. Lola raised $10 million in investments just in 2017. Clue, an app that allows women to monitor and track their menstrual cycles, has raised $20 million.73
Menstrual Hygiene Day, founded only in 2014, saw 349 events in fifty-three countries in its third year of existence. The government of Kenya has now promised to provide free sanitary pads to “every girl child registered and enrolled in a public basic education institution.”74 The government of Uganda, in the form of First Lady and Minister of Education and Sports Mrs. Janet Museveni, promised the same thing in the months before an election.75 None have been provided, and when Dr. Stella Nyanzi criticized the broken promise, as well as calling the president “a pair of buttocks,” she was jailed for four weeks.76 This is the same Mrs. Museveni who once proposed nationwide virginity tests as part of a national “virgin census.”77
In India, the commercial-led campaign called Touch the Pickle was supplanted by a ground-up one called Happy to Bleed, which saw young Indian women nailing sanitary pads to trees, the pads’ top-woven liners covered with messages such as “We bleed! Get over it!” Founded by the twenty-year-old Nikita Azad, Happy to Bleed began as a protest against the banning of menstruating women from temples. (At one temple in southern India, a temple elder proposed installing a “menstrual-scanning” machine, though he hadn’t yet invented such a thing.)78 The temple ban was small-minded and stupid. But, as Azad wrote, any menstrual taboo is about much more than blood. “It is not a question of pure versus impure or men versus women. Our fight begins from our homes and workplaces. Relatives who beat our mothers to abort us, to in-laws who burn us, to those who rape us, to temples that denigrate us.”79 Struggling against stupid taboos was also a fight against entrenched misogyny and its side dish of endemic violence.
There are campaigns now to provide pads to homeless women, also users of socks and whatever works. When I spent a night driving around Saskatoon with a youth outreach charity, which served mostly the poor and indigent, the most commonly requested items were tampons and diapers, and the outreach worker referred to herself with no irony as That Tampon Lady. The American Civil Liberties Union has filed lawsuits on behalf of several incarcerated women because of assaults on their access to menstrual hygiene. In women’s prisons, access to sanitary pads is a far cheaper weapon of control than a firearm. Female prisoners report that they are given sanitary pads in insufficient quantities and of dire quality. Londora Kitchens, an inmate at Muskegon County Jail in Illinois, testified that in 2014 she had been menstruating and had run out of sanitary napkins. “You’re shit out of luck,” said a certain Officer Grieves, and told her to bleed on the floor.80 In a lawsuit filed by Brooklyn Defender Services before the New York City Council on Women’s Issues, an attorney wrote that her client, incarcerated at Rikers, “asked her social worker not to visit her while she was menstruating because she was worried about leaking through her uniform and having to walk the halls of the jail with a bloodstain.”81 Rikers gave its inmates twelve sanitary pads a month, and they were thin and inadequate. In Arizona, women who use up their twelve allotted pads must ask for more. Tampons are forbidden because they are a “security risk,” according to ACLU. State senator Athena Salman recently proposed a bill that would allow prisoners unlimited menstrual hygiene products and not allow prisons to charge for extra. Jay Lawrence, chair of the all-male committee, said, “I’m almost sorry I heard the bill […] I didn’t expect to hear pads and tampons and the problems of periods.”82 He still had to listen to testimony about heavy flow and leaks. Nurse Molly Nygren, who has worked with women prisoners, told reporters of women who fashion tampons by twisting several maxi pads. “That can increase bacteria and cause toxic shock syndrome,” said Nygren, “and I think they shouldn’t have to do that.” The bill passed 5–4.83
Other campaigns focus on tampon taxes. In the United States, tampons merit sales tax though condoms, hair-growth products, and lip balm do not. In the UK, they were taxed at 20 percent until 2000, when the rate dropped to 5 percent.84 This remains one of the few tax cuts that was never publicly announced in the budget, according to Prime Minister Gordon Brown’s former spin doctor Damian McBride, “due to Gordon’s reluctance to refer to tampons at the despatch box.”85 Despite the European Union relaxing its laws to allow states to exempt sanitary protection from tax, that 5 percent tax rate means feminine hygiene products count as luxury items, unlike essential items exempt from VAT such as ice cream, houseboats, and incontinence pads. In 2017, New York State voted to provide adequate sanitary provisions to prisons, homeless shelters, and schools for free. It also revoked the tampon sales tax, as did eight other states.86 Ireland, Spain, and the Netherlands have removed the tampon tax; France has reduced it to 5.5 percent.87 In Switzerland, women filled thirteen Zurich fountains with red dye to protest the taxing of feminine hygiene at 8 percent (the rate reserved for luxury items; day-to-day products get 2.5 percent).88 In the UK the Conservative government pledged to remove the tax, did nothing, then used £250,000 (about $355,000) of sanitary product tax revenue to fund an antiabortion charity (despite promising that tampon tax revenues would support women’s shelters).89 Before he left office, President Barack Obama expressed surprise when he was told that forty US states tax feminine hygiene products as luxury items. “I suspect,” he told the interviewer, “that it’s because men were making the laws when those taxes were passed.”90
How different things would be if men had periods. This is an old idea, and never better expressed than by Gloria Steinem in her peerless and perfect 1978 essay “If Men Could Menstruate.” In this alternate world,
Men would brag about how long and how much.
Young boys would talk about it as the envied beginning of manhood. Gifts, religious ceremonies, family dinners, and stag parties would mark the day.
To prevent monthly work loss among the powerful, Congress would fund a National Institute of Dysmenorrhea.
Sanitary supplies would be federally funded and free. Of course, some men would still pay for the prestige of such commercial brands as Paul Newman Tampons, Muhammad Ali’s Rope-a-Dope Pads, John Wayne Maxi Pads, and Joe Namath Jock Shields “For Those Light Bachelor Days.”
Street guys would invent slang (“He’s a three-pad man”) and “give fives” on the corner with some exchange like, “Man you lookin’ good!” “Yeah, man, I’m on the rag!”91
* * *
At the Association for Parents of Mentally Retarded Children in Coimbatore, Muruga invites me to try the machine. The cellulose is deconstructed by the young lad at the grinder; then I tamp it into a steel box. I compress that, using a simple lever, to form the liquid-absorbing core of the pad. With another manually operated machine, I enclose the pad in fabric, glue the adhesive strip on it, place it under UV light for thirty seconds, like shellac nails in a salon, and it is done. Photos are taken, and in them I am grinning with abandon, because I’ve just made one sanitary pad, regular, called Kangaroo.
Maybe it looks like nothing much. But in the hands of a girl or woman who dries her clothes with shame and risk; who stays away from school because she fears smelling and pain; in the hands of women who earn a living from producing low-cost sanitary pads where before they had none, this pad is holding a lot more than cellulose. It may be called Friend, or Peace of Mind, or Purity, but actually Wings—or Vings—is its best name, because it is freedom, prospects, possibility. All in the shape of 12 grams of compacted, affordable fluffy.
London’s Air Ambulance helicopter landing near Tower Bridge, London
EIGHT
CODE RED
Code Red. Open chest. These phrases become a noise in the room, repeated by staff. They say it almost with wonder to each other, though they are experienced emergency and trauma professionals and they deal with calamity and catastrophe daily and many times a day and night. Adult trauma call. Adult female. Open chest. Code Red. Eight minutes.
As soon as the nurse hangs up the red phone, the one that delivers news of incoming emergencies, the one a passing nurse calls the evil phone, and says “Code Red,” then “open chest,” the atmosphere changes. Now there is tension, intensity, focus. I hear “open chest,” and my mind thinks of pirates and black caskets, florins tipping out on a beach, because I have no idea what an open chest is going to consist of and suddenly everyone is too intent and busy to be asked. My stupid fancies fill the minutes that pass in heightened anxiety until there she is, our Code Red, being wheeled into the resuscitation room at the Royal London Hospital Major Trauma Centre. Her trolley is surrounded by stern staff, some in orange, some in green. By stern, I mean the kind of unsmiling authority you want in someone who is too involved in saving your life for levity.
Now I see what an open chest is.
She is horizontal, and I am sitting away from the bay so as not to disturb, so my eye line sees only her bare feet on the plastic trolley, then strange pink mounds rising out of her torso rising and falling, rising and falling. Her lungs. I have never seen anything like this. I am frozen with shock while everything around me speeds up and intensifies: the number of people in Bay Eight, where she has been taken (ten, then fifteen, then thirty); the activity and movement (constant); the beeping machines (maddening and constant). There is no panic. They are just busy. They have things to do.
A doctor has his hands in her chest and he is massaging her heart. Resuscitation. From the Latin, “to raise again.” The Lazarus ward, this.
And Jesus called in a loud voice, “Lazarus, come out!” The dead man came out, his hands and feet wrapped with strips of linen, and a cloth around his face. Jesus said to them, “Take off the grave clothes and let him go.”1
The French call it “reanimation,” the Germans use “revival.” To restart life; to make someone live. Before, the places where the dangerously and seriously injured went were called moribund wards. In wartime they were also called “dying tents.”2 During the First World War and because of the power of blood transfusion, the name changed to something more hopeful, to possibility, not foregone conclusion. In a trauma department, the resus room is for the most dangerous and serious. At the Royal London this is where paramedics bring people who have endured falls from more than two stories, “bull’s-eyes” (heads that hit a windshield), burns that cover more than 30 percent of a body, traumatic amputations, mangled extremities, stabbings, gunshots. Here they take in “one-unders,” as people who go into and under trains are known, and Code Blacks, people with severe brain injury. They bring the Code Reds. There are very precise ways to assess a Code Red involving blood pressure and hemoglobin levels, but it amounts to this: severe hemorrhage. Bleeding to death.
In a nearby bay there is a man who fell from a height who is a Code Black. The Code Blacks don’t speak. The Code Reds might for a while. Later, in the operating room, the Code Black man becomes a Code Red as well. Two Code Reds in one morning: the Royal London gets several Code Reds a month, but this is still a startling way to start a week. An open chest is even more unusual and so spectators arrive. Soon there is a crowd of medics drawn from all floors of this huge hospital. Their curiosity is the educational kind, not vulgar. She is dying: they want to see how she can be saved.
* * *
A London morning. Rush hour on a busy road that heads into the city, that is shared by buses, cars, bicycles. The woman was cycling to work. She did this every day, as it was a clear ride from her home in one part of the city to her workplace in another. She did this every day, because she probably lived with the belief that all inhabitants of a major city must hold to themselves like treasure: that nothing bad will happen today. Nothing will hit, or crush, or crash into, or stab, or shoot, or damage them. They will not stumble, or slide, or trip, or slump. City dwellers do not think like trauma medics, who designate cases as Car Versus Pedestrian or Pedestrian Versus Truck. This versus, so adversarial, is the truth of city life but one that we cannot afford to accept if we are to continue to function.
She cycled alongside cars and motorbikes and trucks and buses and mopeds and pedestrians and other bikes, and she made it all the way, nearly, until a bus pulled out from a side street; and then for some reason (the investigation is ongoing) she went under the bus and its wheels went over her body. They ran over her pelvis and it was smashed. Smithereens, from an old Irish word meaning “small pieces.” Her bones were smithereens, but also the blood vessels in her pelvis: veins, arteries, capillaries, blood vessels that can be so small, cells pass through them in single file. They are all over the body and they can be broken like bones. All these broken vessels were leaking blood out of her circulation, into places where it should not be. The body needs an adequate volume of blood to feed everything it needs to feed: this is blood pressure. If blood is pouring out of the circulation, then the body starts to starve, sputter, shut down. A vehicle with holes in the fuel tank.
At 8:56 a.m., the police were informed of an accident. The London Ambulance Service arrived, paramedics in dark green uniforms, then the HEMS team in orange. HEMS is the Helicopter Emergency Medical Service, a service that incorporates doctors from the Royal London Hospital and elsewhere; paramedics on attachment from the London Ambulance Service; and flight crew (and helicopters and fast cars) from London’s Air Ambulance, a charity. HEMS is those glamorous types in orange flight suits, moving urgently and importantly with large boxes and bags of equipment like soldiers. It is one of the most advanced trauma teams in civilian life. The HEMS team had come by car, a fast Škoda that is used at night or in poor weather, when the helicopter can’t fly. (The short distance made a helicopter ride pointless.) Two doctors, one paramedic. Quickly, the medics in orange suits set to work alongside the green ambulance staff. They had already made a transformation because this grim roadside on this busy highway was now a place known as “pre-hospital.” Every accident scene everywhere and every time is potentially pre-hospital. But the term has now come to mean a particular thing: that a small team of paramedics and doctors can now perform procedures that they would never have done before in a location like this. In the military, there is a place called “an austere setting.” It is where special forces work, and where everything is limited except danger and difficulty. Although this was a busy gritty road in the middle of a great city, it was austere enough for medics about to do procedures usually performed in sterile, safe, and supervised operating rooms.
At first, trapped under the b
us, the woman was talking. Emergency staff call such cases “talk-and-die”: people who have had horrific injuries, who are crushed and bleeding, can at first talk normally, because at first their body is not yet shutting down. At first it is pausing under the enormity of the insult. This is not my term: medics talk of the insult done to a body. Don’t mistake “talk-and-die” for callousness. It is an alert, a warning to medics not to be fooled, for them to plan for what is coming.
* * *
Bleeding, says Karim Brohi, a trauma and vascular surgeon at the Royal London, “is the biggest disease you have never heard of.”
Nearly six million people a year die of injuries.3 Trauma accounts for 10 percent of the world’s deaths, says the World Health Organization, or “32 percent more than the number of fatalities that result from malaria, tuberculosis and HIV/AIDS combined.”4 In Africa, more people now die from trauma than from AIDS.5 Of people who receive traumatic injuries in civilian life, up to 40 percent die because they were bleeding. Add up all the common infectious diseases, says Brohi, and they don’t even “touch the sides” of bleeding’s death toll. Hemorrhage causes up to 80 percent of all potentially survivable deaths in combat.6
The World Health Organization classes trauma as a disease, because it has a cause—a profound injury to the body—and a treatment. Bleeding has no category of its own, among the categories of things that kill us, but you can see it, seeping through others. Brohi adds up. Postpartum hemorrhage, more than a thousand a year. “Gastrointestinal hemorrhage, two hundred thousand. The WHO categorizes them as injuries or maternal deaths but there are lots of ways to die if you are injured and there are lots of ways to die if you have maternal deaths. Actually these people are dying because they are bleeding.”
